How did you learn about this position? (Newspaper, Internet, Friend, If other-please list):

Have you ever been employed by this facility:

Yes
No

Are you 18 years or older?

Yes
No

Are you a U.S. citizen or an alien legally authorized to work in the United States?

Yes
No

Have you ever been convicted of, or plead guilty to, a crime other than a misdemeanor traffic violation?If yes, which State(s), and explain: (you are not required to disclose any sealed or expunged criminal records.)